Understanding the context of control

Better appreciation of contextual factors is crucial to achieving effective control

Achieving sustained control and eventual elimination of worms is not as simple as providing existing drug treatments to anyone who needs them. It is important that we also understand how contextual factorscan impact upon the effectiveness of treatment, as well as how to increase and maintain levels of treatment coverage.

Improvements in access to safe, clean drinking water and adequate sanitation, as well as appropriate hygiene and health-seeking behaviour, are all necessary for achieving sustained control and elimination of helminths. We have demonstrated how, even in the absence of large-scale control, secular social and economic changes can lead to reductions in the prevalence of STH infection. We are now investigating in the degree by which specific contextual factors, including water and sanitation, impact upon the rate at which individuals become reinfected after treatment, and are working to identify factors that contribute to the persistence or cessation of transmission.

Working with collaborators within LSHTM and at the Kenya Medical Research Institute (KEMRI), we are also interested in understanding the main determinants affecting community responses to control programmes. We are interested in how health behaviours, including hygiene and drug uptake, can be increased and/or sustained. Our earlier work has provided insight into local perceptions of school-based malaria control, and our attention is now focused on consideration of factors influencing community perceptions and acceptability of community-wide deworming.

Lastly, we are increasingly interested in the impact of helminth control programmes on community primary care structures and the broader health system, and understanding the role of such programmes in health system strengthening.

Main areas of recent and current research include:

Modelling contextual factors influencing transmission of helminth infections, including access to water and sanitation

Developing standardised approaches to measuring water, sanitation and hygiene in helminth control programmes

Understanding the factors associated with changes in infection and with the persistence of transmission

Understanding community perceptions of community and school-based treatment programmes

Investigating how helminth control programmes interact with broader health systems